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Study shows increase in arthroplasty for treatment of proximal humerus fractures
Women had a significantly higher frequency of proximal humerus fractures and men were more likely to be treated nonoperatively.
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While nonoperative management of proximal humerus fragility fractures remains the most common treatment among elderly patients, there has been an increase in shoulder arthroplasty for surgical treatment, according to study results.
“Nonoperative management is still common for proximal humerus fractures,” Alan L. Zhang, MD, assistant professor at the University of California, San Francisco, told Orthopedics Today. “But for patients who have surgery, the rate of treatment using shoulder replacement, and in particular reverse total shoulder replacement, is increasing.”
Operative vs. nonoperative care
Zhang and his colleagues obtained associated patient demographics, hospitalization data, treatment and revision status for 259,506 proximal humerus fractures identified in the Medicare database.
Overall, 67% of patients were treated nonoperatively vs. 33% treated operatively with 19.3% treated with open reduction and internal fixation (ORIF); 11.2% with hemiarthroplasty; and 2.4% with reverse or anatomic total shoulder arthroplasty. Across all age groups, nonoperative management was the most commonly used treatment, increasing from 49% in ages 65 years to 69 years to 82% in patients older than 85 years. For surgical treatment, ORIF was the most common surgical treatment in all age groups. However, the rate of ORIF decreased with age (62% of patients aged 65 years to 69 years vs. 54% aged 80 years to 84 years). Further, the rate of surgical treatment with reverse total shoulder arthroplasty increased from 3% in 2005 to 17% in 2012.
A significantly higher frequency of proximal humerus fractures were found among women (79%). According to results, men were more likely than women to be treated nonoperatively (70% vs. 66%) and with ORIF (66% vs. 57%), while women were more likely than men to have hemiarthroplasty (35% vs. 28%) and anatomic or reverse total shoulder arthroplasty (8% vs. 6%).
A 96.7% implant survival rate without revision was observed for all surgical options, according to patient data collected during 2 years. Results showed a 1-year survival rate of 96.5% and a 2-year survival rate of 95.3% for ORIF without revision ORIF or conversion to another procedure.
“For operative treatment, [this study] shows there is good early survival regardless of the type of surgery performed and a low risk for reoperation,” Zhang said.
He added, “I was surprised by how well the patients did after surgery because this is an elderly population with multiple medical complications. But the results show surgical treatment may be a good options when needed.”
Validated outcomes measurement
Zhang noted prospectively collected cohort data are warranted and future research should focus on collecting patient-outcome measures, which this study did not assess. – by Casey Tingle
- Reference:
- Han RJ, et al. J Shoulder Elbow Surg. 2016;doi:10.1016/j.jse.2015.07.015.
- For more information:
- Alan L. Zhang, MD, can be reached at the Department of Orthopaedic Surgery at the University of California, San Francisco, 1500 Owens St., Box 3004, San Francisco, CA 94158; email: alan.zhang@ucsf.edu.
Disclosure: Zhang reports no relevant financial disclosures.